12080207 CITY OF CUPERTINO BUILDING PERMIT
BUILDINGADDRESS: 1160SSTELLINGRD CONTRACTOR:HOMEOWNER PERMITNO: 12080207
OWNEIVS NAME: SAN JOSE GOSPEL PIONEERS INC IN DA'Z'E ISSUED:08202012
OWNFR'S PHONE: 6508048783 CUPERTINO.CA 95014 PHONE NO:
❑ LICENSED CON'I'RACI'OR'S DECLARATION .1011DESCRIPTION: RESIDE\PIAL 0 COMMISRCIALU
License Class Lie. REMOVE AND REPLACE SIDING THE SOUTH SIDE OF
THE
Contractor Dale MAIN BUILDING AND CLASSROOM BUILDINGS
1 hereby affirm that I am licensed under the provisions mf Chaptcr 9
(commencing wish Section 7000)of Division 3 of(he Business S Professions
Code and that my license is in full force and effect.
hereby affirm under penally of perjury one of the following two declarations:
I liave and will maintain certificate of consent to self-insure far Worker's
Compensation,as provided for by Section 3700 of the Labor Code,for the
performance of the workfor which this permit is issued. Sq.Ft Floor Arca: Valuation:$5000
1 have and will maintain Worker's Compensation Insurance,as provided for by
Section 3700 of the Labor Code,for the performance of the work for which this U'N Number:36225029.00 Occupancy Type
permit is issued.
A PPLIC.wT CERTIFICATION
I certitythat I have read(his application and state that the above information is PERMIT EXPIRES IF WORK IS NOT STARTED
correct.1 agree to comply with all city and county ordinances and state Imes relating WITHIN 180 DAYS OF PERMIT ISSUANCE OR
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes. (We)agree to save 180 DAYS FROM LAST CALLED INSPECTION.
indemnify and keep harmless the City of Cupenino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of diel 2��1
granting of this permit. Additionally,the applicant understands mid will comply Issued by'� a[e:
with all non-point source regulations per the Cupertino Municipal Code.Section
9.18.
RE-ROOFS: l
Signature Date All roofs shall be inspected prior to any roofing material being installed.If a roof is
installed without first obtaining an inspection,I agree to remove all new materials for
inspection.
OWNER-BUILDER DECLARA'T'ION
Signature of Applicant: Date:
I hereby affirm that 1 am exempt from the Contractor's License lane for one of
the follo%%ing two reasons: ALL ROOF COVERINGS TO BE CLASS"A"OR BETTER
I,as owner of the property,or my employees with wages as(heir sole compensation,
will do the work,and the structure is not intended or offered for sale(Sec.7044,
Business d Professions Code)
1,as owner of the property,am exclusively contracting with licensed contractors to DAZARDOUS MATERIALS DISCLOSURE
construct the project(Sec.7044,Business&Professions Code). I have read the hazardous materials requirements under Chapter 6.95 of the
California Health&&Safety Code,Sections 25505.25533,and 25534. 1 will
hereby affirm under penally of perjury one of the following three maintain compliance with the Cupertino Municipal Code,Chapter 9.12 and the
declarations: Ilea11h S Safety Code.Section 25532(x)should I store or handle hazardous
I have and will maintain a Certificate of Consent to self-insure for Worker's material. Additionally,should I use equipment or devices which emit hazardous
Compensation,as provided for by Section 3700 of the Labor Code,for the air contaminants as defined by the Ras Area Air Quality Management District I
performance of the work for which this permit is issued, will maintain coin I' wit It[he Cup 'no Municipal Code.Chapter 9.12 and
I have and will maintain Worker's Compensation Insurance,as provided for by the Health S Safeq'Cade.Sections -i0 .2553 ,a d 25534.
Section 3700 of the Labor Code,for the performance of the work for which this
Oumer or authorized t Date:
Penni(is issued. 8
1 certify that in the performance of die work for which dies permit is issued,I shall
not employ any person in any manner so as to become subject to the Worker's
Compensation.laws of California. If,after making this cer ilicate of exemption,1 C.ONS'1'It IICI'IO,C LENDING AGENCY
become subject to the Worker's Compensation provisions of the Labor Code,I must I hereby affirm that there is a construction lending agency for the performance of
forthwith comply with such provisions or this periit shall be deemed revoked work's for which this permit is issued(Sec.3097,Civ C.)
Lender's Name
APPLICAN I'CERTIFICATION Lender's Address
I certify[hat I have read this application mid state that the above information is
correct. I agree to comply with all city and county ordinances and state law's relating
to building construction,mid hereby authorize representatives of this city to enter
upon the above mentioned property for inspection purposes.(We)agree to Saye ARCH II'I'ECI"S DFCL,\RATION
indemnify and keep harmless the City of Cupertino against liabilities,judgments,
costs,and expenses which may accrue against said City in consequence of the I understand my plans shall be used as public records.
granting of this permit.Ar monally,the applicant understands and will comply
with all non-point so a gul i its per the Cupertino Municipal Code,Section Licensed Professional
9.18.
Signature Date PJ Z
77zn/He Himself might come tti have first
place in evenvhing.Colossians 1:18
July J I. 2012
City of Cupertino
Building and Permit Department
10'00 Torre Avenue
Cupertino, CA 9014
Re; Flilliview Bible Chapel
1160 S. Stelling Road
Cupertino, CA 95014
To Whom It May Concern:
San .lose Gospel Pioneer Corporation, Hillview Bible Chapel gives permission for Scott
McBirney to act on our behalf as agent representative in order to obtain building permits
and interact with city inspectors for the South Wall Siding Repair Work Project at the
address above.
Please feel free to contact n1e should there be any questions or further clarifications
needed.
Sincerely,
John ' Shepherd
President
San Jose Gospel Pioneers
2012
1160 South Stelling Road, Cupertino, CA 95014 Phone: 408.446.0996
Mailing Address: P.O. Box 892, Cupertino, CA 95015
CITY OF CUPERTINO
FEE ESTIMATOR - BUILDING DIVISION
ADDRESS: 1160 S. Stelling DATE: 08/20/2012 REVIEWED BY: jsg
:121 APN: BP#: 'VALUATION: $
°PERMITTYPE: Building Permit PLAN CHECK TYPE: Tenant Improvement
PRIMARYPENTANIATION
USE: Commercial Building PE 1ATI
WORK Remove and replace damaged siding, like for like
SCOPE
OCCUPANCY"TYPE: TYPE OF FLR AREA CONSTR. (s.f.) PC FEES PC FEE ID BP FEES RP FEE ID
A(Tenant Improvements) u-13,111-B,IV,V-B 0 $0.00 $0.00
TOTALS: 0 $0.00 $0.00
MECH, HOURLY Q Yes (D No PLUMB, HOURLY Q Yes 0 No ELEC, HOURLY Q Yes Q No
Slech. Plan Check Planih.Plan Chec6 Flee.Plan Chack
Mech. Permit Fee: Plumb.Permit Fee: Flec, Pennit Fee:
Orher,llech.Insp. Odrer Plumb Insp. Ll I Other Fier.lisp.
Hech.hup.Fee: Plumb. hup.Fra: Mee.lisp.Fee:
A'OTE: This wiuutte does trot include jeer due to other Departments(i.e. Planning, Public HOrks, Fire,Sanitary Sewer District,School
District,etc.). These feev are hosed an the prefiatinan information available and are only an estimate. Contact file De t or adchl'I info.
FEE ITEMS (Fee Resolution 11-053 Eff 7/1111) FEE QTY/FEE MISC ITEMS
Plan Check Fee: $0.00 Select a Misc Bldg/Structure
Suppl. PC Fee: Q Reg. Q OT 0.0 hrs $0.00 or Element of a Building
PML' Plan Check: $0.00
Permit Fee: HourIv Only? Q Yes (2) No $0.00
Suppl. Insp. Fee:Q Reg. Q OT 0,0 hrs $0.00
PME Unit Fee: $0.00
PML"- Permit Fee: $0.00
Consn-uction Tux:
Administrenive Fee: Q
Work Without Permit? Q Yes (j) No $0.00 E)
AdvancedPlanning Fee: $0.00 1� hours Inspections Q
Travel Documentation Fees: $133.00 IST/NSP Inspection, Hourly 0
Strone Motion Fee: 1,00 $D-eo Travel Documentation
131de, Suis Commission Fee: ,5D $0.00 $45.00ITRAVDOC 7966
SUBTOTALS: $0.00 $178.001 TOTAL FEE: 00
Revised: 07/01/2012
4. L�
CONSTRUCTION PERMIT APPLICATION6��
COMMUNITY DEVELOPMENT DEPARTMENT• BUILDING DIVISION
10300 TORRE AVENUE • CUPERTINO, CA 95014-3255
CUPERTINO 1 (408) 777-3228 • FAX (408) 777-3333• buildino(fcupertino.oro / A�OOac
no r7
❑NEW CONSTRUCTION ElADDITION ® ALTERATION/TI ElREVISION/DEFERRED ORIGINAL PERMfr H (�
1/ PROJECT ADDRESS APN 0.. 36a_a 5—oAq
OKTJER NAME PHONE E-MAIL
I G wM �. ov'1 � �7$
STREET ADDRESS ,( /1 CITY. STATE,ZIP FAX
✓A/Yl< rJ A /JI/C G J N O
CONTACT NAME (� PHONE E-MAIL
Mc?> SO '404 ' 814 ST L Lw1�0
STREET ADDRESS CITY,STATE, ZIP FAX
66 �4VL . m"Lo TA+� gYozs
El OWNER 11In OWNER-BUILDER O"-MRAGENT ❑ CONTRACTOR ❑CONTRACTOR AGENT ❑ ARCHITECT 11 ENGWEER ❑ DEVELOPER ❑ TENANT
CONTRACTOR NAME LIC SENUMB R LICENSETYPE BUS.LIE
6YYt
COMPANY NAME EOL FAX
STREET ADDRESS CITY.STATE,LP PHONE
ARCHITECT/ENGINEER NAME LICENSE NUMBER BUS.LIC#
COMPANY NAME E-MAIL FAX
t4. G
STREET ADDRESS CITY.STATE,ZIP PHONE
lf6o
S. .a cJ No -2iI - 23S8
DESCRIPTION OF WORK
W b J O^J
OJ O IN V J Vla. IN
EXISTING USE PROPOSED USE CONSTR.TYPE 1 9STORIES
USE TYPE OCG SQ.FT. VALUATION(S)
EXISTG NEW FLOOR DEMO TOTAL
AREA AREA AREA NEr AREA
BATHROOM KITCHEN OTHER
REMODEL AREA REMODEL AREA REMODEL AREA
PORCH AREA DECK AREA TOTAL DECKTORCH AREA GARAGE AREA: DETACH
❑ATTACH
a DWELLING UNITS: ISASECOSDUNIT ❑ITS SECOND STORI' 11 YES
nF.IN'G Ann Enr ONO ADUI'1'ION: ANO
PRE-APPLICATION OYES IF YES.PROVIDE COPYOF ISTHEBLDG AN ❑YES RECEIVED BY: ., TOTAL V,6LUATION�
PLANNINGAPPLM ONO PLANNING APPROVAL LETTER EICHLF.RHOM, ONO
By my signature below,1 certify to each of the following: 1 am the property owner or authorized agent to act on the property owner's behalf. I have read this
application and the information I have provided is correct. I have read the Description of Work and Verify it is accurate. 1 agree to comply with all applicable local
ordinances and state laws relating to bpuildq COv6ction. I author' representatives of Cupertino to enter the above-ide ified property for inspection purposes.
Signature of Applicant/Agent: Date: 2e
SUPPLEMENTALINFORb1AT10NRE ' PI:6CHI:CK1YPE ROUTING SLIP
New SFD or Multifamily dwellings: Apply for demolition permit for - �, -
existing building(s). Demolition permit is required prior to issuance of building
(1\ER='1'i11:C011�TE:R• dt UILDINO 1'1_\\\`RF,YIF.N',
permit for new building. 'EI EXPRESS _PL.iNN'iNc rl:yry REVIEW
_Commercial Bldgs: Provide a completed Hazardous Materials Disclosure C1 STANDARD ElPUBLIC WORKS. -
form if any Hazardous Materials are being used as pan of this project. ❑' LARQE-s ❑ :FIRE Di:PP .
_Copy of Planning Approval Letter or Meeting with Planning prior to El ,MAJOR," ❑,'SANITARY SEWER DISTRICT
submittal of Building Permit application. ,- --
_.
❑. ENVIRONMENTAL fIL\LT11,_
R1dgApp201 Ldoc revised 06121111